Building toward Universal Access for TB diagnosis in Malawi

Malawi has a serious epidemic of tuberculosis (TB), with an estimated incidence of 346/100,000 all cases and 132/100,000 for sputum smear positive (SS+) cases in 2007. A low detection rate of 41% of SS+ cases means many with TB are unidentified and continue to spread TB. Community Sputum Collection Points (CSCP) were introduced under the National TB Program's (NTP) new policy Universal Access to TB Diagnosis in Malawi 2007-2011 to improve case detection.

Methods

With district health staff, Project HOPE educated community members to increase awareness of TB and TB/HIV, and trained volunteers on collecting sputum from TB suspects at CSCPs. Sputum containers, transport boxes and recording and reporting forms were provided. CSCPs were linked with health facilities to provide TB testing and supervision. Focus groups and in-depth interviews were conducted with volunteers to get recommendations to improve access.

Results

Project HOPE and District TB staff trained 575 community leaders and volunteers on TB, TB/HIV and TB diagnosis and helped open CSCPs in two districts, increasing community awareness, reducing stigma and increasing TB testing. Community volunteers report increased respect in supporting TB testing, and more people are being identified with TB and getting treatment. Challenges remain for timely transportation of sputum, with long distances to health facilities.

Recommendations

Additional CSCPs are needed to help implement Universal Access in Malawi, and review of successes and challenges in the current sites should inform future strategies to ensure impact on TB control.